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MIDTERM > **Quick Hits > Flashcards

**Quick Hits Flashcards

1
Q

Examples of zero order kinetics?

A

Aspirin
Phenytoin
Warfarin
Heparin
Theophylline

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2
Q

Zero vs First order kinetics?

A

Zero - Constant amount of drug is eliminated

First - Constant Fraction of drug is eliminated

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3
Q

What are the three examples of phase 1 reaction?

A

Oxidation- Removes electron
Reduction - Adds electron
Hydrolysis- Adds water (ester)

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4
Q

Theophylline has a low hepatic extraction ratio. Which will have a greater effect on metabolism - prolonged hypotension or CYP inhibition?

A

CYP inhibition
**
1. High hepatic ER (>0.7) is dependent on perfusion
2. Low hepatic ER (<.3) is dependent on enzymes

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5
Q

How do enzyme inducers affect clearance?

A

Increase clearance — require more drug

Ex: tobacco, ethanol, barbituates

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6
Q

How do enzyme inhibitors affect clearance?

A

Decrease clearance
Need less drug

Ex: Grapefruit, SSRI

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7
Q

What is potency and how is it measured?

A

Dose required to achieve clinical effect.

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8
Q

What is the ED50 and ED90 a measure of?

A

Potency.

How much drug to achieve clinical effect in 50% and 90% of the population

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9
Q

Drug A is further left on the curve, what does this mean?

A
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10
Q

When two drugs has the same efficacy, but one is further left, what does this mean?

A

Both can achieve the same clinical effect, but need a higher dose of Drug B

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11
Q

What does the slope of the dose response curve tell you?

A

Steeper slope means a small increase in drug has a profound effect

Flatter slope means a higher dose is required to increase its clinical effect

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12
Q

What is therapeutic index? How is it measured?

A

TD50/ ED50

Wide TI means a wide margin of safety

Narrow TI means a small margin of safety

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13
Q

What is a racemic mixture?

A

Equal amounts of two enantiomers

Ex: Bupivacaine, iso, des, ketamine, ephedrine

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14
Q

Two ways propofol is cleared from the body?

A
  1. PY450
  2. Lungs
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15
Q

When should Ketamine be given? When shouldn’t it? How does it effect each system?

A

NEED INTACT SNS

  1. Increases everything
  2. Bronchodilates
  3. Relives somatic pain
  4. Blocks wind up
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16
Q

When should etomidate not be given? What is helpful with?

A
  1. Does not cause seizures with no seizure history BUT great for mapping seizures with hx of them
  2. Great hemodynamic stability with mild respiratory effects
  3. NEVER give with adrenocortical issues like sepsis
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17
Q

What drugs should be avoided in porphyria ?

A

Barbs
Etomidate
Ketamine
Amio
Toradol

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18
Q

How is porphyria treated?

A

Fluids
Glucose
Heme arginate
Normothermia

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19
Q

Gold standard of ECT?

A

Methohexital - decreases seizure threshold

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20
Q

How do most GABA agonists work? What about benzos?

A

Most increase channel time

Benzos- Increase frequency

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21
Q

Which induction drugs have an active metabolite?

A

Ketamine
Versed

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22
Q

Blood: Gas solubilities?

A

Des - .42
N2O - .46
Sevo - .65
Iso - 1.45

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23
Q

What are the 4 tissue groups? Amount of CO for each group?

A

Vessel rich (10%) - 75% of CO

Muscle (50%) - 20% of CO

Fat (20%) - 5% of CO

Vessel poor (20%) 1%

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24
Q

How do gases effect cerebral blood flow?

A

Uncouples, CMRO2 decreases and CBF increases

Nitrous does not uncouple

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25
Q

What is a MAC hour?

A

1% sevo x 2 hours
2% sevo x 1 hour
4% sevo x 30 minutes

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26
Q

Which gas is not metabolized to TFA?

A

Sevo

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27
Q

What is diffusion hypoxia ? How is it treated?

A

N2O dilutes alevolar O2 and depresses respiratory drive

Treat with 100% O2 for 3-5 minutes

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28
Q

Which inhalation anesthetics are most greatly effected by R-L shunt?

A

Des (lower solubility)

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29
Q

Which inhalation anesthetics are most greatly effected by L-R shunt?

A

None

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30
Q

How many more times soluble is nitrous?

A

34x

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31
Q

How long should nitrous be avoided when placing an SF6 bubble? What is a safe to use with nitrous?

A

7 days

Silicone oil has no contraindication

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32
Q

What factors do not affect MAC?

A

K
Mag
Thyroid
Gender
HTN

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33
Q

What is the meyer-overton rule?

A

Lipid solubility is directly proportional to potency

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34
Q

Most important site of halogenated anesthetic c action on the brain?

A

GABA

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35
Q

How does Nitrous work?

A

NMDA antagonism
P2P channel

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36
Q

Which gas contributes to conoral steal syndrome?

A

Iso

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37
Q

Which factor influences anesthetic uptake the least?

A

FGF

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38
Q

What determines local onset of action?

A

pKa

**closer pKa is to pH, the faster the onset

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39
Q

What determines local anesthetic potency? What is the secondary determinant?

A

Lipid solubility

Intrinsic vasodilating effect

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40
Q

What determines duration of action?

A

Protein binding*

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41
Q

Which local has the lowest protein binding?

A

Chloroprocaine - 0

Procaine - 6

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42
Q

Which local has the highest pKa? Lowest?

A

Procaine - 8.9

Mepivacaine - 7.6

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43
Q

Rank injection sites with highest Cp

A

IV
Tracheal
Interpleural
Intercostal
Caudal
Epidural
Brachial
Femoral
Sciatic
Subq

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44
Q

Max dose of chloroprocaine with epi?

A

1000

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45
Q

Max dose of lidocaine? with epi?

A

300

with epi - 500

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46
Q

Max dose of Bupivacaine? With epi?

A

175

with 200

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47
Q

Which local has high cardiotoxicity?

A

Bupivacaine

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48
Q

Most common sign of local toxicity?

A

Seizure except bupivacaine is cardiac arrest

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49
Q

What are appropriate levels of locals?

A

1-5

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50
Q

What level are first symptoms seen with locals?

A

5-10

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51
Q

What level is cardiovascular collapse seen?

A

> 25

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52
Q

What conditions increase LAST?

A

Hypercarbia
Hyperkalemia
Metabolic acidosis

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53
Q

Best choices for treatment of LAST?

A

Amiodarone and Lipids

Avoid epi, vasopressin

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54
Q

Max dosage for tumescent anesthesia ? What other complications are seen?

A

50mg/kg

Pulmonary edema, LAST

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55
Q

What two locals produce a leftward shift on the oxyhemoglobin dissociation curve?

A

Prilocaine and benzocaine

Also

Cetacaine
EMLA (Prilocaine+lidocaine)

AND

Nitro, Nipride, Phenytoin

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56
Q

Treatment of methemoglobinemia ? Who is at high risk?

A

Methylene Blue

Glucose-6-phosphate deficiency
Infant

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57
Q

What drugs are adjuncts for locals?

A

Clonidine
Epi
Opioids

58
Q

Which local reduces the effectiveness of opioids?

A

Chloroprocaine

59
Q

What drug helps locals diffuse through tissue?

A

Hyaluronidase

60
Q

Patients with upregulation of extra junctional receptors need more or less of: depolarizers, nondepolarizers?

A

*DO NOT USE SUCC

*Need more Non depolarizers

61
Q

Is fade observed with Succ?

A

NO

Phase 1 blocks will either have twitches or no twitches

*amplitude will be decreased

62
Q

Phase 1 vs Phase 2 block

A

1- no fade

2- fade present

63
Q

Where is onset of NMB best measured? Recovery?

A

Onset - Oculi
Recovery - Ulnar

64
Q

Is succ safe with renal failure?

A

Yes if normal K level

65
Q

What is the Dibucaine test? What is normal?

A

Normal is 80, which means dibucaine has inhibited 80% of pseudocholinesterase

66
Q

What is the treatment for hyperkalemia arrest caused by succ? Why?

A

Ca - it raises the RMP

67
Q

Highest rates of myalgia following succ?

A

Young adults, specifically women

Children, elderly, pregnant have the lowest

68
Q

How can myalgia be reduced? What does not help?

A

ROC

NSAIDS
Lidocaine
Higher dose of succ

**opioids do not help

69
Q

Order of NMB from highest to lowest

A

Roc
Atra
Miv + Panc
Vec
Cis

70
Q

What is the metabolite of atra and cis? Why does this matter?

A

Laudanosine - increases seizure

71
Q

Where is roc metabolized? active metabolite?

A

Liver

72
Q

Do vec and panc have active metabolites?

A

Yes

73
Q

Which NMB have a histamine release?

A

Succ, atra, miv

74
Q

Which NMB has a vagolytic effect?

A

Panc

75
Q

Which NMBs should be avoided with hypertrphic cardiomyopathy?

A

Panc, Atra, miv

76
Q

What is the main way to inhibit acetylcholinesterase?

A

Formation of carbamyl esters

Ex; Neostigmine, pyridostigmine, Physostigmine

77
Q

Which AchE inhibitor passes through the BBB?

A

Physostigmine

78
Q

Common side effects of giving too much AchE I?

A

Increased in PNS

79
Q

Which antimuscarinic does not pass through the BBB?

A

Glyco

80
Q

When can atropine cause paradoxical bradycardia?

A

Too small of a dose

81
Q

How does inflammation effect pain transduction?

A

Reduced threshold to pain (Allodynia)

Increased response (hyperalgesia)

82
Q

Max dose of cocaine?

A

200mg

83
Q

What is EMLA cream consist of? Dressing? Onset of action?

A

50% Lidocaine and 50% Prilocaine

Onset - 1 hour

Need dressing

84
Q

Which local is metabolized to o-toluidine?

A

Prilocaine

85
Q

What is the metabolite in ester locals?

A

Para-aminobenzoic acid

86
Q

Easy calculation for bupivacaine?

A

0.5% - divide weight in half

1.0% - 1 per / kg

87
Q

Which local is unionized?

A

Benzocaine

88
Q

Which Ion does not pass through the nicotinic receptor?

A

Chloride

89
Q

Which antiemetic can prolong succ duration?

A

Metoclopramide

90
Q

What is Hoffmans elimination dependent on?

A

pH and temperature

91
Q

Which agent potentiates NMB the most?

A

Des

92
Q

What test confirms anaphylactic to a NMB?

A

Tryptase

93
Q

Do locals have an effect on TMP or RMP?

A

NO

94
Q

Are local’s weak acids or bases?

A

Weak bases

95
Q

What is the MOA of locals?

A

Conjugate acid binds to the INTRAcellular sodium channel

96
Q

Max dose of experal?

A

266 mg or two vials

97
Q

Dose of lipids for LAST?

A

1.5mg/kg

98
Q

Most common cause of death with patients undergoing tumescent? When is a general indicated?

A

PE

Greater than 2-3 liters being used

99
Q

Which additives prolong duration of action of locals?

A

Dextran
Epi
Dexamethasone

100
Q

What conditions are contraindicated with succ?

A

Guillain Barre
MS
Marre Tooth

101
Q

Ester linkage drugs undergo what type of metabolization?

A

Hydrolysis

102
Q

Which Ca channels are blocked?

A

L type

103
Q

Which disease is seen with a strawberry tongue and an increased risk of coronary artery aneurysm?

A

Kawasaki’s disease

104
Q

Most common cause of death with an LVAD?

A

Infection

105
Q

What does the Law of LaPlace explain?

A

AAA

Tension = Pressure * Radius

106
Q

What does the low pressure test, test?

A

Flow control valves to the common gas outlet

107
Q

What conditions cause a large V wave?

A

Tricuspid regurgitation
Acute increase in volume
RV papillary muscle ischemia

108
Q

Normal PAOP (wedge pressure)

A

5-15

109
Q

What conditions cause PAOP to underestimate LVEDV?

A

Aortic regurgitation

110
Q

When does thermodilution underestimate CO?

A

Too cold
Too much volume

111
Q

When can’t thermodilution predict CO?

A

Tricuspid regurg
Shunt

112
Q

On a PA waveform, where is the catheter when there is a increase in diastolic pressure but systolic stays the same?

A

Tip is in the PA

113
Q

On a PA waveform, where is the catheter when there is a increase in systolic pressure but diastolic stays the same?

A

RV

114
Q

What opioids produce a metabolite? What do they cause?

A

Meperidine - seizures
Morphine - Resp depression

115
Q

Which opioid has the largest Vd? Smallest?

A

Largest - Fent

Smallest - Remi

116
Q

What is the only opioid that antagonizes NMDA?

A

Methadone

117
Q

Which opioid can cause prolonged QT?

A

Methadone

118
Q

Best treatment for muscle rigidity?

A

Paralysis and intubation

119
Q

Common characteristics of partial opioids?

A

-Produce analgesia with reduced respiratory depression
-Ceiling effect
-Reduce the efficacy
-Can cause withdrawal
-Low addiction

120
Q

Which opioid reversal is least likely to reverse respiratory depression?

A

methylnaltrexone

121
Q

Which opioid antagonist has the longest duration of action?

A

Naltrexone

122
Q

How is the Kappa receptor unique?

A

Anti shivering
Diuresis
Dysphoria
Delirium
Hallucinations

123
Q

Opioid potency Chart?

A
124
Q

Mallampati chart

A
125
Q

LMA sizes

A
126
Q

What must you do with a grade 4 Cormack and Lehane score?

A

Use an alternate approach to intubation

127
Q

On a king airway, what lumen is used to ventilate when the tip is in the esophagus? The trachea?

A

Blue - esophagus
White - trachea

128
Q

What three axis must be aligned when intubating?

A

Oral
Pharyngeal
Laryngeal

129
Q

During OLV, what is applied first; CPAP or PEEP? Which lung?

A

1.CPAP to Non-dependent lung is first
2.PEEP to dependent lung second

(C is before P)
(Dependent lung is already doing well)

130
Q

What blood test indicates a higher risk of PPCs?

A

Albumin < 3.5

131
Q

What does a Mill Wheel murmur signify?

A

Air embolism

132
Q

On PFTS, with restrictive disease what Dynamic volumes are normal?

A

FEV1 to FVC ratio and FEF 25-75% are both normal

***Everything else is decreased

133
Q

On PFTS with obstructive disease, what values are normal?

A

RV, FRC, TLC are all normal

Everything else is decreased

134
Q

With an intrathoracic obstruction, is inhalation or exhalation normal?

A

Inspiration is normal

(Pulls open obstruction)

135
Q

With an extrathoracic obstruction, is inhalation or exhalation normal?

A

Exhalation is normal, pushes obstruction open

136
Q

What PFT is the most sensitive indicator of small airway disease?

A

FEF 25-75%

137
Q

What is a normal FEV1 value?

A

> 80%

138
Q

What is a normal FEV1/FVC ratio?

A

> 80%

139
Q

What tests are used to assess dynamic and static airways?

A

Dynamic - Moving of air - (PFTs) FEV1. FVC, MMEF, ratio

Static - How much lungs can hold at a single point, RV, ERV, Vt, FRC, TLC

140
Q

What test can measure how well the lungs can transfer gas?

A

DLCO - diffusing capacity of carbon monoxide

141
Q

Which PFT is the best test of endurance?

A

MMV - Maximum Voluntary Ventilation over 1 minute

Normal - 150L men
100L women

MIDTERM (6 decks)

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